rev. 10/17
APPLICATION PACKET
Dear Prospective Applicant,
Thank you for your interest in applying for an apartment at GK Management Co., Inc.
All information requested in the application packet must be completed. Incomplete applications will not
be considered. If the information requested does not apply to you, please indicate by using “N/A” for not
applicable.
This will tell us that you understand the requested information and you did not intentionally leave it
blank. If you make a mistake or typo, please draw a single line through the errors and put your initial.
Please do not use whiteout to correct the errors.
Please confirm that you have completed, signed, and returned the following forms:
1) Subsidized Rental Application
2) Supplemental to Application for Federal Assisted Housing HUD-92006
Once your application has been received at the property, your name will be placed on the
waitlist based on the date and time application is received at the property.
It’s your responsibility to contact us when there is a change in your family composition and/or change of
address. You will receive a Periodic Assessment on an annual basis. If we do not receive the Periodic
Assessment, you will be removed from our waiting list.
The apartments are offered on a first come, first serve basis. As your name reaches the top of the wait
list, you will be required to come in for an interview. At that time, you will be asked to sign the
authorization forms which allows our staff to further verify, income, assets, allowances, criminal history,
sex offender status, credit history and landlord references to determine your eligibility for housing.
If you have any questions, please contact us at our community phone number above.
Thank you for your application inquiry.
Page | 1
OFFICE USE ONLY
GK Management Co., Inc. DATE _______________ TIME ______________
PROCESSED BY: __________________________
COMMUNITY NAME: ______________________
SUBSIDIZED RENTAL APPLICATION
Please complete ALL sections. Enter “None” or N/A” for those questions which do not apply.
APPLICATION FOR HOUSING
PART I. HOUSEHOLD INFORMATION
FIRST NAME: MIDDLE INITIAL: LAST NAME:
_________________________________________________________________________________________________________________________________________
CURRENT ADDRESS APT. #: CITY: STATE: ZIP CODE:
_________________________________________________________________________________________________________________________________________
DATE OF BIRTH: SS NO. (LAST FOUR DIGITS): DRIVER’S LICENSE #:
_________________________________________________________________________________________________________________________________________
DAY PHONE#: EVENING PHONE#: CELL PHONE#: EMAIL:
HOUSEHOLD INFO: List ALL household members who will live in the unit, including yourself. Apartment to be occupied by _________________ number of people.
All applicants applying for rental assistance will be required to either submit (a) evidence of citizenship, (b) eligible immigration status, or (c) choose not to claim eligible
s status at the time of the interview for this community.
NAME
RELATIONSHIP TO
APPLICANT
BIRTH DATE
AGE
SOCIAL
SECURITY #
(LAST FOUR
NUMBERS)
STUDENT
1.
SELF
YES NO
2.
YES NO
3.
YES NO
4.
YES NO
5.
YES NO
6.
YES NO
7.
YES NO
8.
YES NO
The Department of Housing and Urban Development has established requirements that housing assistance is directed
to those with the most urgent housing needs. If you think you may be eligible for the preference required by individual
programs pursuant to statute or based upon HUD regulation, please check the corresponding box below.
I have been displaced from an urban renewal area, or as a result of government action, or as a result of disaster determined by the President to be
a major disaster. I am 62 years old. I am handicapped or disabled. N/A
Do you or any member of your household require a unit with accessibility features? Yes No
If YES, what features: Mobility Impairment Visual Impairment Hearing Impairment Other
Do you or any member of your household require reasonable accommodation due to disability that requires changes to our rules,
policies, procedures, or physical modification(s) to the dwelling unit or common areas? Yes No
I agree to provide documentation sufficient to verify my qualification for a preference when the community manager requests that I do
so. If my eligibility for a preference changes in the future, I will contact the community manager.
Initial_____ Date ____________
Page | 2
Part II. General Questionnaire
1.
Have you or any adult member of your household ever been evicted? Yes No If yes, when? Please explain.
2.
Have you or any adult member of your household ever been convicted of a misdemeanor or felony? Yes No
If yes, when? Please explain.
3.
Do you or any adult member of your household currently use any illegal drug or other illegal controlled
substance?
Yes No If yes, please explain:
4.
We maintain separate waiting lists for each apartment size. Which waitlist do you want to be placed on? Transfers are only
permitted for reasonable accommodation. We will only contact you for vacancies that occur in the apartment size that
you select.
Please select all that apply. Studio 1 Bedroom 2 bedroom 3 bedroom 4 bedroom
5.
Do you expect changes to your household size within the next 12 months? Yes No If yes, provide name.
6.
Is there a live-in aide who will be residing with you in the unit? Yes No If yes, provide name.
7.
How did you hear about us? Walk-in/drive by Internet _________________ Newspaper ________________
Referred by: _______________________________ Other (please specify): __________________________
LIFETIME SEX OFFENDER: Are you, or is any member of the household subject to a lifetime sex offender registration in any state?
Yes No
Part III. Housing References Please list current and previous landlords for the last five years
If yes, which family member? Which State?
If yes, which family member? Which State?
Explain details:
Explain details:
Address of Present Residence:
Present Landlord Name:
Landlord Telephone:
)
Fax:
)
Present Landlord Mailing Address: City, State: Zip
Code:
Monthly rent:
$
# of bedrooms:
Is your rent subsidized?
Rent
How long have you lived at this address? Reason for wanting to move?
Months
Is there anyone living with you now that will not be moving with you to this property?
If yes, who? And why
?
If you have lived at your current address less than five years, what was your previous address?
Previous Address:
Name of previous Landlord:
Landlord Telephone:
)
Fax:
)
Previous Landlord Mailing Address: City, State: Zip Code:
Monthly
rent:
$
How long have you lived at this
address?
Months
Reason for moving?
Page | 3
Part IV. Income Information
Current Income (Employment Sources)
List all full and/or part-time employment income for all household members. (Include self-
employment gross earnings and net taxable earnings)
Full Name Name of Employer
Length of
Employment
Income: $_______________
Full Name Name of Employer
Length of
Employment
Full Name Name of Employer
Length of
Employment
Income: $_______________
Income: $______________
Full Name Name of Employer
Length of
Employment
List all states in which you and all adult household members have lived since the age of 18:
Income: $ _______________
Page | 4
Other Sources of Income
(examples: list all public assistance, social security, S.S.I., pension, retirement, CAPI, disability
compensation, unemployment compensation, veterans benefits, insurance policies, interest income,
babysitting, care- taking allowance, alimony, child support, annuities, trusts, dividends, regular
contributions, scholarships, grants, armed forces, and student financial aid.)
Full Name
Type of Income
Amount
$
Per
Full Name
Type of Income
Amount
$
Per
Full Name
Type of Income
Amount
$
Per
Assets include checking and savings accounts, equity in real property, stocks, bonds, and other forms of capital investment. Do not
include automobiles or furniture. If you have no assets, write “none” in the space.
Checking Account
Savings account
Bank Name: ________________________________________
Account Number:
___________________________________
Cash Value/Balance: _________________________________
Bank Name: _______________________________________
Account Number: __________________________________
Cash Value/Balance: ________________________________
Stocks and Bonds Value:
Other Account:
Bank Name: ________________________________________
Account Number: ___________________________________
Cash Value Balance: _________________________________
Other Account
Bank Name: ________________________________________
Account Number: ___________________________________
Cash Value Balance: _________________________________
Other Account
Bank Name: ________________________________________
Account Number: ___________________________________
Cash Value Balance: _________________________________
Other Account
Bank Name: ________________________________________
Account Number: ___________________________________
Cash Value Balance: _________________________________
Other Account
Bank Name: ________________________________________
Account Number: ___________________________________
Cash Value Balance: _________________________________
401K/403B/IRA
Bank Name: _______________________________________
Account Number: ___________________________________
Cash Value Balance: ________________________________
Savings Bond Value:
Page | 5
We are an equal housing opportunity provider. All persons will be treated fairly and equally without regard to race, color, religion,
sex, familial status, handicap, or national origin in compliance with the Fair Housing Act. Your signature below authorizes
management to obtain a “consumer report” at any time during the application process or any time after initial occupancy as defined
in the Fair Credit Reporting Act, 15 U.S.C. Section 1681 a(d), seeking information on creditworthiness, credit standing, credit capacity,
character, general reputation, personal characteristics, or mode of living. Owner or agent has the right to reject this application at
any time prior to execution of a lease agreement. If applicant(s) withdraws application, applicant’s name will be removed from the
waiting list.
APPLICANT(S) HEREBY REPRESENTS THAT THE STATEMENTS ON THIS APPLICATION ARE TRUE AND CORRECT AND AUTHORIZES
INQUIRIES OF ANY STATEMENT MADE HEREIN.
NOTIFY US IN WRITING OF ANY CHANGE TO INFORMATION PROVIDED WITHIN THIS RENTAL APPLCATION.
APPLICANT SIGNATURE
X
DATE
CO-APPLICANT SIGNATURE
X
DATE
CO-APPLICANT SIGNATURE
X
DATE
CO-APPLICANT SIGNATURE
X
DATE
AUTHORIZED GK MANAGEMENT CO., INC. REPRESENTATIVE SIGNATURE
DATE:
Mail completed and signed application directly to community.
TO BE PROCESSED, THIS APPLICATION MUST BE FILLED OUT COMPLETELY AND SIGNED. rev.6/17
If yes, where? What is the current value?
Have you ever owned Real Estate or Real Property?
If yes, when? Where? When Sold? How Much?
Have you or any adult member of your household disposed of any assets within the last 2 years for less than fair market
value? If yes, what was disposed and for how much?
OMB Control # 2502-0581
Exp. (
02/28/2019)
Supplemental and Optional Contact Information for HUD-Assisted Housing Applicants
SUPPLEMENT TO APPLICATION FOR FEDERALLY ASSISTED HOUSING
This form is to be provided to each applicant for federally assisted housing
Instructions: Optional Contact Person or Organization: You have the right by law to include as part of your application for housing,
the name, address, telephone number, and other relevant information of a family member, friend, or social, health, advocacy, or other
organization. This contact information is for the purpose of identifying a person or organization that may be able to help in resolving any
issues that may arise during your tenancy or to assist in providing any special care or services you may require. You may update,
remove, or change the information you provide on this form at any time. You are not required to provide this contact information,
but if you choose to do so, please include the relevant information on this form.
Applicant Name:
Mailing Address:
Telephone No: Cell Phone No:
Name of Additional Contact Person or Organization:
Address:
Telephone No: Cell Phone No:
E-Mail Address (if applicable):
Relationship to Applicant:
Reason for Contact: (Check all that apply)
Emergency
Unable to contact you
Termination of rental assistance
Eviction from unit
Late payment of rent
Assist with Recertification Process
Change in lease terms
Change in house rules
Other: ______________________________
Commitment of Housing Authority or Owner: If you are approved for housing, this information will be kept as part of your tenant file. If issues
arise during your tenancy or if you require any services or special care, we may contact the person or organization you listed to assist in resolving the
issues or in providing any services or special care to you.
Confidentiality Statement: The information provided on this form is confidential and will not be disclosed to anyone except as permitted by the
applicant or applicable law.
Legal Notification: Section 644 of the Housing and Community Development Act of 1992 (Public Law 102-550, approved October 28, 1992)
requires each applicant for federally assisted housing to be offered the option of providing information regarding an additional contact person or
organization. By accepting the applicant’s application, the housing provider agrees to comply with the non-discrimination and equal opportunity
requirements of 24 CFR section 5.105, including the prohibitions on discrimination in admission to or participation in federally assisted housing
programs on the basis of race, color, religion, national origin, sex, disability, and familial status under the Fair Housing Act, and the prohibition on
age discrimination under the Age Discrimination Act of 1975.
Check this box if you choose not to provide the contact information.
Signature of Applicant
Date
The information collection requirements contained in this form were submitted to the Office of Management and Budget (OMB) under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3520). The
public reporting burden is estimated at 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing
and reviewing the collection of information. Section 644 of the Housing and Community Development Act of 1992 (42 U.S.C. 13604) imposed on HUD the obligation to require housing providers
participating in HUDs assisted housing programs to provide any individual or family applying for occupancy in HUD-assisted housing with the option to include in the application for occupancy the name,
address, telephone number, and other relevant information of a family member, friend, or person associated with a social, health, advocacy, or similar organization. The objective of providing such
information is to facilitate contact by the housing provider with the person or organization identified by the tenant to assist in providing any delivery of services or special care to the tenant and assist with
resolving any tenancy issues arising during the tenancy of such tenant. This supplemental application information is to be maintained by the housing provider and maintained as confidential information.
Providing the information is basic to the operations of the HUD Assisted-Housing Program and is voluntary. It supports statutory requirements and program and management controls that prevent fraud,
waste and mismanagement. In accordance with the Paperwork Reduction Act, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information, unless the
collection displays a currently valid OMB control number.
Privacy Statement: Public Law 102-550, authorizes the Department of Housing and Urban Development (HUD) to collect all the information (except the Social Security Number (SSN)) which will be
used by HUD to protect disbursement data from fraudulent actions.
Form HUD- 92006 (05/09)
click to sign
signature
click to edit
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